Residents In Obstetrics Research Articles

The training of obstetric physicians and nurses to change the obstetric model in Brazil: A view of the preceptors in the training process

Background and objective: In obstetrics training, there are gaps in the scientific evidence on how to teach safe practices with respect. The objective of this study was to explore from the point of view of the preceptors how the process of training obstetricians (physicians and nurses) in residency leads to the development and inculcation of the practices recommended by the national and international guidelines for assistance with natural childbirth.Methods: Qualitative, exploratory-descriptive study. Thirty-five professionals, including 21 physicians and 14 nurses, from a public institution in the Midwest of Brazil participated in the study. Data were collected through face-to-face interviews conducted from March to June 2018. They were categorized into emerging themes, supported by NVivo to natural birth ® software. Two researchers reviewed the data, and by consensus, the identified issues were confirmed.Results: Of the participants’ comments, 4 themes were codified: approach of the good practices in natural childbirth care; unnecessary practices that remain in use; norms and routines in natural childbirth care; and work processes in the obstetric residency program.Conclusions: The results highlight the necessity of reorganization of the work processes in the residency program, with continuous action directed toward the strengthening of pedagogical processes and the qualification of the actors involved in the formation and organization of childbirth care services to expand the disruptive potential of new health professionals.

Assessing Trauma History in Pregnant Patients: A Didactic Module and Role-Play for Obstetrics and Gynecology Residents.

IntroductionAssessing and addressing patient histories of trauma constitute a critical component of care for vulnerable populations such as pregnant patients, yet they often go unrecognized in obstetric care. Obstetric providers may feel poorly equipped to address this issue comfortably and effectively.MethodsWe designed this didactic module for obstetric residents with previous experience taking patient histories and delivering clinical care. The module was delivered with a faculty member and three additional facilitators with expertise in communication skills training. The session included 60 minutes of background information followed by a 15-minute presentation of a communication template for assessing trauma history. Using a practice case, residents had 45 minutes to practice in small groups, with the facilitators serving as the patient in the role-play.ResultsIn the 2015-2016 academic year, 21 obstetric residents participated in this module. All residents (100%) endorsed favorable beliefs regarding the importance of assessing trauma history and using trauma-informed care. On average, three-fourths (77%) demonstrated basic awareness of issues related to trauma in medical populations. Most residents (>85%) reported a high sense of efficacy in delivering trauma-informed care in some areas, while fewer (64%) reported efficacy specifically in educating patients about signs and symptoms of traumatic stress.DiscussionThe module was well received overall, with participants indicating that clinical training in trauma-informed communication was needed to enhance their sense of efficacy in this area. This learning exercise provided training in a critical communication skill while highlighting areas for further development.

Impact of COVID-19 on Brazilian medical residencies in obstetrics and gynecology.

According to program directors, the COVID‐19 pandemic in Brazil has resulted in a lack of protection and salary payment for one third of OBGYN postgraduate residents, as well as a lack of adequate training.

Determination of error level of ultrasonographic fetal weight estimation according to the seniority of residents in obstetrics and gynecology

Objectives: We consider the difference between estimated fetal weight and birth weight through the measurement according to the seniority of the residents in obstetrics and gynecology. In this study, we aimed to determine the fallibility of the residents according to their seniority years.Methods: This research was planned as a prospective and approved by the Ethics Committee Ultrasonographic measurements were performed with ultrasound device and the estimated fetal weight was calculated with Hadlock 4 (BPD, HC, AC, FL) formula. Measurements were performed by the residents in the first, second, third and fourth year of training and repeated by the same specialist for each patient. Only those who gave birth within 48 hours of the ultrasonographic measurements were included in the study.Results: A total of 392 pregnant women were included in the study. Ninety-eight pregnant women were examined by 1st year resident, 100 pregnant by 2nd year resident, 93 pregnant by 3rd year resident and 101 pregnant by 4th resident. Largest difference between the estimated fetal weight and birth weight was performed by the fourth year resident with 125.06 ± 247.40 grams.Conclusions: The estimated fetal weight by ultrasonography has an important place in obstetric practice and it may vary according to the years of seniority of the resident. For this reason, ultrasonography should be used effectively and accurately during the training of the residents in the centers of education in obstetrics and gynecology and it is essential that the residents learn the ultrasound examination properly and completely.

Medical Residency in Gynecology and Obstetrics in Times of COVID-19: Recommendations of the National Specialized Commission on Medical Residency of FEBRASGO.

The COVID-19 pandemic (Coronavirus Disease 2019) has affected residencies training around the world. In the light of responses to the pandemic, many medical residencies are being forced to reorganize their rotations. These changes include a reduction in the operating room and outpatient care training, and the cancellation of some activities such as visits to the wards, simulation sessions, among others.[1]

Lung ultrasonography in pregnant women during the COVID-19 pandemic: an interobserver agreement study among obstetricians.

PurposeThis study investigated interobserver agreement in lung ultrasonography (LUS) in pregnant women performed by obstetricians with different levels of expertise, with confirmation by an expert radiologist.MethodsThis prospective study was conducted at a tertiary "Coronavirus Pandemic Hospital" in April 2020. Pregnant women suspected to have coronavirus disease 2019 (COVID-19) were included. Two blinded experienced obstetricians performed LUS on pregnant women separately and noted their scores for 14 lung zones. Following a theoretical and hands-on practical course, one experienced obstetrician, two novice obstetric residents, and an experienced radiologist blindly evaluated anonymized and randomized still images and videoclips retrospectively. Weighted Cohen's kappa and Krippendorff’s alpha tests were used to assess the interobserver agreement.ResultsFifty-two pregnant women were included, with confirmed COVID-19 diagnosis rate of 82.7%. In total, 336 eligible still images and 115 videoclips were included in the final analysis. The overall weighted Cohen’s kappa values ranged from 0.706 to 0.912 for the 14 lung zones. There were only seven instances of major disagreement (>1 point) in the evaluation of 14 lung zones of 52 patients (n=728). The overall agreement between the radiologist and obstetricians for the still images (Krippendorff's α=0.856, 95% confidence interval [CI], 0.797 to 0.915) and videoclips (Krippendorff's α=0.785; 95% CI, 0.709 to 0.861) was good.ConclusionThe interobserver agreement between obstetricians with different levels of experience on still images and videoclips of LUS was good. Following a brief theoretical course, obstetricians' performance of LUS in pregnant women and interpretation of pre-acquired LUS images can be considered consistent.

Gender inequality in leadership and academic rank in academic reproductive endocrinology programs.

To identify gender differences in leadership and academic rank within academic reproductive endocrinology (REI) programs with fellowships in the USA. Official institutional websites of the 2017-2018 American Board of Obstetrics and Gynecology (ABOG)-accredited reproductive endocrinology fellowship programs were reviewed, and gender representation at each leadership position and academic rank (Division and Fellowship Director and Full, Associate, and Assistant Professor) was recorded. Univariate comparisons were performed using Chi-square tests, with significance at p<0.05. Among 49 ABOG-accredited reproductive endocrinology programs, 263 faculty were identified, 129 (49.0%) male and 134 (51.0%) female. Division directors were 69.3% male and 30.7% female (p = 0.006). Similarly, fellowship directors were 65.3% male and 34.6% female (p = 0.03). Full professors (n = 101) were more frequently male (70.3% vs. 29.7%, p < 0.001). There was no difference in gender among associate professors (n = 60, 51.7% male vs. 48.3% female, p = 0.79), while significantly more assistant professors were female than male (n = 102, 73.6% vs. 26.4%, p < 0.001). While a majority of residents in obstetrics and gynecology and half of reproductive endocrinology academic faculty are female, women are still underrepresented among leadership positions and full professors in academic reproductive endocrinology programs with fellowship programs.

Evaluation of Operating Room Learning Environment for UAE Obstetrics and Gynecology Residents Using STEEM

Background The quality of the learning environment in the operating room (OR) is vital for the training of surgical residents. Tools with validity evidence exist to measure resident perceptions of the operative learning environment, yet to date no studies have assessed this environment for obstetrics and gynecology residency programs in the United Arab Emirates (UAE). Objective We explored perceptions of obstetrics and gynecology residents regarding their operative learning environment in 2 hospitals in Abu Dhabi, UAE. Methods Our cross-sectional study was conducted in 2018 using the validated Surgical Theater Educational Environmental Measure (STEEM) questionnaire for trainee assessments in the OR learning environment. The 4 STEEM subscales measure teaching and training, learning opportunities, overall atmosphere and supervision, workload, and support, respectively. Cronbach's alpha and intraclass correlation were used to establish the internal consistence and reliability of the questionnaire. We calculated an overall score and compared scores between the 2 institutions using Student's t test. Results Thirty-one residents completed the questionnaire (18 at Corniche Hospital and 13 at Al Ain Hospital). The overall average STEEM score was 142.1. The score for residents at Corniche Hospital was 134.9 and that for Al Ain Hospital was 152.2, with better overall scores on 3 STEEM domains at Al Ain Hospital. Conclusions Our study showed that obstetrics and gynecology residents in the UAE have a positive perception of their operative learning environment. We also identified areas for improvement.

Editorial introductions

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Emre SeliEmre SeliEmre Seli, MD, is Professor of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, USA. Dr Seli received his medical degree from the University of Istanbul, Turkey, and completed his residency in obstetrics and gynecology at Yale University. His postdoctoral training included a fellowship in reproductive endocrinology and infertility as well as a research fellowship in molecular biology, both at Yale University. The primary focus of his research program is to understand and treat infertility. His laboratory characterized mechanisms regulating translational activation of gene expression in the oocyte. Dr Seli and his colleagues also made seminal contributions to our understanding of oocyte and embryo competence in IVF and the potential role of non-invasive diagnostic technologies in this context. Dr Seli is the recipient of many National Institutes of Health (NIH) and pharmaceutical industry-sponsored research grants. He has trained more than 50 pre- and post-doctoral fellows, published more than 100 scientific articles, and received numerous research awards, including the Ira and Ester Rosenwaks New Investigator Award from the American Society for Reproductive Medicine (ASRM), and the President's Achievement Award from the Society for Reproductive Investigation (SRI). Dr Seli's current research focuses on determinants of oocyte and embryo health, and mechanisms of ovarian ageing. Dr Seli is actively involved in professional societies and scientific journals. He served as the Program Director for SRI in 2016, where he is now the Program Committee Chair (2016–2021). He has also been a member of the ASRM Research Committee for the past five years, and served as a member of the SSR Program Committee, where he organized the Ovarian Workshop in 2016 and 2018. He is the Associate Editor for Molecular Human Reproduction, Reproductive Sciences, Journal of Assisted Reproduction and Genetics, and Reproductive Biomedicine Online, and is currently co-editor of Current Opinion in Obstetrics and Gynecology. As an educator, Dr Seli delivered more than 150 invited lectures nationally and internationally, and he is the recipient of the Association of Professors of Gynecology and Obstetrics (APGO) Excellence in Teaching Award based on evaluations of his lectures by Yale Medical Students. Dr Seli edited four books (Non-invasive Management of Gynecologic Disorders, Infertility, Fertility Preservation, and Human Gametes and Pre-implantation Embryos: Assessment and Diagnosis) and is currently co-authoring the 9th edition of the Speroff's Clinical Gynecologic Endocrinology and Infertility. Juan A. García VelascoJuan A. García VelascoProfessor Juan A. García Velasco is Director of IVI RMA-Madrid, Spain. He gained his degree in medicine at Complutense University, Spain, in 1990, before going on to train as a specialist in obstetrics and gynecology at La Paz Hospital, Spain, between 1992 and 1995. Professor García Velasco gained his PhD in medicine and surgery at Autónoma University, Spain, in 1995. He then became a sub-specialist in reproductive endocrinology and infertility at Yale University, USA, in 1998. Professor García Velasco has published 122 scientific articles in impact journals along with 22 chapters and four books. He is the Principal Investigator of projects funded by the Ministry of Education and the Ministry of Health. He is the Co-Editor of Reproductive Biomedicine Online (RBMO) and a member of the Editorial Committee of Fertility & Sterility (ASRM), Society for Gynecologic Investigation (SGI), European Society of Human Reproduction and Embryology (ESHRE), Spanish Society of Obstetrics (SEGO) and Gynecology and Spanish Society of Fertility (SEF).

Technique of Midline Abdominal Incision Closure Among Surgical Trainees

Background: Technique of anterior abdominal wall closure (AAWC) determines wound-related surgical complications. Residents in obstetrics and gynecology and surgery departments perform most midline abdominal wall closure; data is lacking on how it is being done. This study identifies abdominal wall closure techniques used.&#x0D; Methods: A descriptive study was carried out from October 2015 to May 2016.&#x0D; Results: 71 (35 surgical, 36 ObGyn) residents completed a self-administered questionnaire. Knowledge of midline abdominal closure was acquired from medical officers (58.6%) or consultants before residency (28.6%). Absorbable suture was preferred for clean wounds by 75% of residents; 70% used size 1 suture for fascial closure. Most residents (95.7%) closed fascia in clean wound by continuous suturing. Interrupted suturing was preferred in contaminated and dirty wounds. Half of the residents in both groups would close skin in contaminated wounds, while 16% of surgery and 9.4% ObGyn will close skin in dirty wounds.&#x0D; Conclusion: Inconsistencies exist in anterior abdominal wall closure between groups of residents despite presence of clear guidelines. It is important to harmonize training on AAWC at the tertiary hospital.&#x0D; Keywords: Abdominal closure, Midline incision, Wound complications

Hysterectomy Route and Numbers Reported by Graduating Residents in Obstetrics and Gynecology Training Programs.

Hysterectomy Route and Numbers Reported by Graduating Residents in Obstetrics and Gynecology Training Programs.

Biosafety of Sonography: Survey of Current Knowledge and Practice Patterns in Obstetrics Providers.

Sonography is routinely performed in obstetrics. For safety purposes, intensity-output displays are included in all ultrasound machines. There are few studies performed on provider understanding of ultrasound safety. We sought to assess obstetrics providers' level of knowledge on ultrasound biosafety before and after educational intervention. This is a cross-sectional study using survey research to examine the knowledge of obstetrics providers performing sonography. The study included faculty, fellows, and residents in obstetrics and gynecology and family medicine, and certified nurse midwives. After completion of the initial survey, subjects were randomly assigned to 1 of 3 educational interventions. The interventions included reading an article, watching an educational video, or viewing a PowerPoint presentation. After completing the intervention, subjects answered a post-intervention survey. A total of 138 responses were received from the initial survey. Fifty-eight individuals completed the intervention and post-intervention survey. Across all levels of training and practice, before intervention, 70% of providers indicated that they did not recognize output display standard functions. Of the 58 individuals who completed the intervention and both surveys, all knowledge-based questions resulted in statistically significant improvements in scores. Sonography is increasingly used in the obstetric setting, and it is essential that providers and trainees understand the risks of the procedures they perform. Our data suggests a need for improved education on ultrasound safety. Improvement in scores on the post-intervention knowledge assessment suggests that the educational interventions used may be beneficial in enhancing provider understanding of obstetric ultrasound safety.

A Randomized Cross-Over Trial Focused on Clinical Breast Exam Skill Acquisition Using High Fidelity versus Low Fidelity Simulation Models in Rwanda

Breast cancer incidence is rising for women in low and middle income country (LMIC)s. Growing the health care workforce trained in clinical breast exam (CBE) is critical to mitigating breast cancer globally. We developed a CBE simulation training course and determined whether training on a low-fidelity (LF) simulation model results in similar skill acquisition as training on high-fidelity (HF) models in Rwanda. A single-center randomized educational crossover trial was implemented. A preintervention baseline exam (exam 1), followed by a lecture series (exam 2), and training sessions with assigned simulation models was implemented (exam 3)-participants then crossed over to their unassigned model (exam 4). The primary outcome of this study determined mean difference in CBE exam scores between HF and LF groups. Secondary outcomes identified any provider level traits and changes in overall scores. The study was implemented at the University Teaching Hospital, Kigali (CHUK) in Rwanda, Africa from July 2014 to March 2015 PARTICIPANTS: Medical students, residents in surgery, obstetrics and gynecology, and internal medicine residents participated in a 1-day CBE simulation training course. A total of 107 individuals were analyzed in each arm of the study. Mean difference in exam scores between HF and LF models in exam 1 to 4 was not significantly different (exam 1 0.08 standard error (SE) = 0.47, p = 0.42; exam 2 0.86, SE = 0.69, p = 0.16; exam 3 0.03, SE = 0.38, p = 0.66; exam 4 0.10 SE = 0.37, p = 0.29). Overall exam scores improved from pre- to post-intervention. Mean difference in exams scores were not significantly different between participants trained with HF versus LF models. LF models can be utilized as cost effective teaching tools for CBE skill acquisition, in resource poor areas.

Understanding of changes in abortion rate following liberalization of abortion law among Brazilian residents in obstetrics and gynecology.

To evaluate residents' knowledge about the evolution of abortion rates in countries where abortion has been legalized, and to assess whether such knowledge correlates with residents' sociodemographic characteristics and experience in abortion care. A multicenter, cross-sectional study was conducted in 21 Brazilian hospitals with 404 medical residents in obstetrics and gynecology. Data collection occurred during February 2015 through January 2016. Data were collected through a self-administered, anonymous questionnaire. The χ2 test, Fisher exact test, and multiple logistic regression analysis were performed. Of residents, 60% believed that the abortion rate would increase after legalization; 82% had been involved in the care of women with incomplete abortion and 71% in the care of women admitted for legal abortion. Associations were found between knowledge of the evolution of the abortion rate after legalization and region of birth, region of medical school, and importance attached to religion. Multiple regression confirmed that studying medicine in the south/southeast of Brazil and attaching little importance to religion were associated with knowing that legalization does not lead to an increase in abortion rate. Information relating to abortion in medical schools and during residency is very limited and should be improved.

97: Preparing for FLS: A survey of residents in obstetrics & gynecology

97: Preparing for FLS: A survey of residents in obstetrics & gynecology

Hysterectomy Route and Numbers Reported by Graduating Residents in Obstetrics and Gynecology Training Programs.

To characterize trends in self-reported numbers and routes of hysterectomy for obstetrics and gynecology residents using the Accreditation Council for Graduate Medical Education (ACGME) case log database. Hysterectomy case log data for obstetrics and gynecology residents completing training between 2002-2003 and 2017-2018 were abstracted from the ACGME database. Total numbers of hysterectomies and modes of approach (abdominal, laparoscopic, and vaginal) were compared using bivariate statistics, and trends over time were analyzed using simple linear regression. Hysterectomy data were collected from 18,982 obstetrics and gynecology residents in a median of 243 (interquartile range 241-246) ACGME-accredited programs. The number of graduating residents increased significantly over time (12.1/year, P<.001), whereas the number of residency programs decreased significantly (0.52 fewer programs per year, P<.001) over the 16-year period. For cases logged as "surgeon," the median number of abdominal hysterectomies decreased by 56.5% from 85 (interquartile range 69-102) to 37 (interquartile range 34-43) (P<.001). The median number of vaginal hysterectomies decreased by 35.5% from 31 (interquartile range 24-39) to 20 (interquartile range 17-25) (P=.002). The median total number of hysterectomies per resident decreased by 6.3% from 112 (interquartile range 97-132) to 105 (interquartile range 92-121) (P=.036). In contrast, the median number of laparoscopic hysterectomies increased by 115% from 20 (interquartile range 13-28) in 2008-2009 to 43 (interquartile range 32-56) in 2017-2018, despite the decrease in overall number of hysterectomies (P<.001). These trends were statistically significant. The total number of hysterectomies performed by obstetrics and gynecology residents in the United States is decreasing, and the routes are changing with decreases in abdominal and vaginal approaches, and an increase in use of laparoscopic hysterectomy.

Knowledge on medical abortion among Brazilian medical residents in Gynecology and Obstetrics.

Medical or drug-induced abortion has been proven as an effective means for termination of pregnancy. However, training of providers in the use of misoprostol has been limited. The current article aims to identify the degree of knowledge on medical abortion among Brazilian medical residents in Gynecology and Obstetrics. A multicenter cross-sectional study was performed with residents regularly enrolled in residency programs in Gynecology and Obstetrics in 21 teaching hospitals. A self-responded questionnaire was used. Correct responses to each of the alternatives were identified, and a binary response variable (≥ P70, < P70) was defined by the 70th percentile of the number of questions on misoprostol. Four hundred and seven medical residents returned the questionnaire, of which 404 were completed and three were blank. The majority (56.3%) of the residents were 27 years or younger, females (81.1%), and single or not living with a partner (70%). Two-thirds (68.2%) were in the first or second year of residency. Only 40.8% of the participants answered 70% or more of the questions correctly. In the multivariate analysis, enrollment in the third year of residency or greater (OR = 2.18; 95%CI: 1.350-3.535) and having participated in treatment of a woman with induced or probably induced abortion (OR = 4.12; 95%CI: 1.761-9.621) were associated with better knowledge on the subject. Among Brazilian medical residents in Gynecology and Obstetrics, knowledge on medical abortion is very limited and poses an obstacle to proper care in cases of legal termination of pregnancy.

Barriers to Access of Medical Abortion in Brazil: The Role of Resistance by Obstetricians and Gynaecologists

Objective: According the WHO, not only gynaecologists but also other physicians, midwives and nurses can provide abortion services as safe and effectively as specialist. Considering the number of willing providers of legal abortion is limited, it is important to know the opinion of Ob &amp; Gyn specialists regarding prescription of misoprostol for voluntary termination of pregnancy (VTP) by other professionals. Study Design: A multicenter cross-sectional study carried out in 21 teaching hospitals in Brazil, aiming to determine who should be allowed to prescribe misoprostol for voluntary termination of pregnancy from the perspective of 407 residents in Obstetrics and Gynaecology who returned a self-responded questionnaire, 404 completed and three blank. Result(s): Less than 8% of residents stated that other doctors besides specialists should be allowed to prescribe misoprostol for VTP. The proportion of residents who agreed to allow any physician to prescribe misoprostol for VTP was twice as large for those who had received information about the use of misoprostol in medical residency (15.1%). The logistic regression indicated that being male, in stable marital union and not giving very much importance to religion were significantly associated with agreement to allow any physician to prescribe misoprostol for voluntary termination of pregnancy. Conclusion(s): The results showed an extremely low acceptance of non-specialist or midwives and nurses to prescribe misoprostol for VTP, which is against the WHO recommendations and world experience. We believe that contrasting such behavior with evidence-based recommendations may help to change such restrictive positions in a not so distant future.

Evaluation of a Medical Residency Program in Gynecology and Obstetrics

Abstract: Introduction: Medical residency in gynecology and obstetrics is unquestionably important in the training of physicians who choose this specialty of the Brazilian Ministries of Health and Education. However, studies evaluating these residency programs are scarce, especially regarding the reflexive qualitative aspects of the research. Therefore, this exploratory and descriptive study aimed to evaluate the current medical residency program in gynecology and obstetrics of the School of Medical and Health Sciences at Pontifícia Universidade Católica de São Paulo (PUC-SP) using a quantitative and qualitative approach. Method: The methodology included a comparative curriculum analysis between the program recommended by the National Committee of Medical Residency until 2018 and the program offered by PUC-SP School of Medical and Health Sciences, as well as a self-administered questionnaire completed by individuals who graduated between 2007 and 2018. Results: The most significant findings of the comparative curriculum analysis include discrepancies in the percentage arrangement of annual workload, indicating an overload of on-call duty hours, and unequal distribution of internships. The questionnaire response rate was 66% (41 of 62 participants). Most respondents were women (n=32, 78%), who worked mainly in the cities of Sorocaba (n=21, 43.7%) and São Paulo (n=10, 21%). Most medical graduates were partially satisfied with the program (n=34, 82.9%). Some responses also matched the findings of the comparative curriculum analysis, such as dissatisfaction with the number of gynecological surgical procedures performed (n=39, 95.1%). Regarding the content analysis of open-ended answers, categorized according to Bardin, the graduates appreciated activities in obstetrics, and the most relevant criticisms were related to fewer hours assigned to certain activities, especially those devoted to gynecological surgical practices and theoretical activities. Conclusions: Based on the findings, suggestions were proposed and accepted by the managers for changes that should have a positive impact on the medical residency program. This research contributes to the diagnostic evaluation of a traditional medical residency program in Brazil, proposes improvements, and uses reproducible methods, thus serving as a comparison basis for other studies so that advances can be made in the training of these specialists.

Evaluation of a Medical Residency Program in Gynecology and Obstetrics

Abstract: Introduction: Medical residency in gynecology and obstetrics is unquestionably important in the training of physicians who choose this specialty of the Brazilian Ministries of Health and Education. However, studies evaluating these residency programs are scarce, especially regarding the reflexive qualitative aspects of the research. Therefore, this exploratory and descriptive study aimed to evaluate the current medical residency program in gynecology and obstetrics of the School of Medical and Health Sciences at Pontifícia Universidade Católica de São Paulo (PUC-SP) using a quantitative and qualitative approach. Method: The methodology included a comparative curriculum analysis between the program recommended by the National Committee of Medical Residency until 2018 and the program offered by PUC-SP School of Medical and Health Sciences, as well as a self-administered questionnaire completed by individuals who graduated between 2007 and 2018. Results: The most significant findings of the comparative curriculum analysis include discrepancies in the percentage arrangement of annual workload, indicating an overload of on-call duty hours, and unequal distribution of internships. The questionnaire response rate was 66% (41 of 62 participants). Most respondents were women (n=32, 78%), who worked mainly in the cities of Sorocaba (n=21, 43.7%) and São Paulo (n=10, 21%). Most medical graduates were partially satisfied with the program (n=34, 82.9%). Some responses also matched the findings of the comparative curriculum analysis, such as dissatisfaction with the number of gynecological surgical procedures performed (n=39, 95.1%). Regarding the content analysis of open-ended answers, categorized according to Bardin, the graduates appreciated activities in obstetrics, and the most relevant criticisms were related to fewer hours assigned to certain activities, especially those devoted to gynecological surgical practices and theoretical activities. Conclusions: Based on the findings, suggestions were proposed and accepted by the managers for changes that should have a positive impact on the medical residency program. This research contributes to the diagnostic evaluation of a traditional medical residency program in Brazil, proposes improvements, and uses reproducible methods, thus serving as a comparison basis for other studies so that advances can be made in the training of these specialists.